Provider Demographics
NPI:1891712816
Name:RICHARD D GORDON, M.D., P.A.
Entity Type:Organization
Organization Name:RICHARD D GORDON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-757-5665
Mailing Address - Street 1:380 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 704
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1845
Mailing Address - Country:US
Mailing Address - Phone:215-757-5665
Mailing Address - Fax:215-757-3128
Practice Address - Street 1:380 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 704
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1845
Practice Address - Country:US
Practice Address - Phone:215-757-5665
Practice Address - Fax:215-757-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07650482Medicaid
PA584117Medicare PIN
PA584117Medicare ID - Type Unspecified